Proximal Aneurysm of the Anterior Cerebral Artery: Case Report and Literature Review

Abstract

Introduction: Aneurysms of the proximal segment (A1) of the anterior cerebral artery (ACA) are rare, accounting for approximately 1% of intracranial aneurysms. Associated vascular anomalies, such as fenestration, complicate diagnosis and treatment, requiring careful planning. Case Report: A 51-yearold woman presented with sudden onset headache. Angio-MRI and digital subtraction angiography revealed a saccular aneurysm measuring 16 x 10 mm in the left A1 segment of the ACA, associated with a fenestrated artery. Due to the complex anatomy and risk of perforator artery damage, microsurgical clipping via the pterional approach was chosen. The patient had a favorable outcome, with early discharge and no permanent deficits. Discussion: A1 aneurysms are challenging due to their proximity to critical structures and anatomical variations. Despite the current trend toward endovascular approaches, open surgery remains preferable in cases with a high risk of complications. Conclusion: Treatment of A1 segment aneurysms should be individualized. In complex cases, the microsurgical approach combined with advanced imaging techniques provides good outcomes and greater safety in managing these rare lesions.